Study Shows Most OEF/OIF Veterans who Screen Positive for Depression Receive Timely Assessments for Suicidal Ideation
Psychiatric disorders, in particular depression and PTSD, are common among Veterans and have been associated with suicide and suicidal behaviors. VA has developed multiple approaches to improve the detection and response to suicide risk, including: improving access to mental health services; enhancing the delivery of evidence-based treatments; implementing a wide range of education programs for VA staff, Veterans, and caregivers; and establishing national toll-free crisis hotline and web-based chat programs. In 2007, VA also designated assessment for possible suicidal ideation among Veterans with positive depression or PTSD screens as a national performance goal. Brief structured assessment (BSA) tools for suicidal ideation, which employ five or fewer items, are now administered across VA as part of routine care following positive screens. This study describes BSA processes, including frequency of administration, among OEF/OIF Veterans who screened positive for depression — and identifies individual and system factors that are associated with BSA completion. Using VA and DoD data, investigators identified 1,662 OEF/OIF Veterans who received healthcare between 4/08 and 9/09 at one of three VAMCs located in the Northwest, Southwest, and Northeast. The primary outcome was receipt of BSA among those Veterans who screened positive for depression in primary care or mental health ambulatory clinics. Investigators also examined associations among demographic, clinical (e.g., comorbid disorders), and utilization (e.g., primary care vs. mental health clinic) variables, and BSA completion.
- Overall, 81% of Veterans received a BSA for suicidal ideation within one month of screening positive for depression, and 94% of BSAs were conducted within one day of positive screens.
- Assessment for suicidal ideation was 50% to 80% more likely to occur when Veterans received a diagnosis of PTSD or depression, respectively, on the day of assessment. Neither race/ethnicity nor age was associated with BSA receipt.
- There was substantial variation in BSA processes, including clinical setting, staff administration, assessment instruments used, and rates of BSA completion over time. For example, Veterans in VAMC 3 were more likely to receive depression screens and BSAs in mental health settings than Veterans seen in VAMCs 1 and 2. Veterans from VAMC 2 were twice as likely to be administered a BSA by a nurse or medical assistant compared to the other two sites, while Veterans from VAMC 3 were twice as likely to be administered a BSA by a psychologist.
- This study included OEF/OIF Veterans only.
- Veterans already receiving depression care are not required to receive depression screening, although many are still screened. This limited the investigators' ability to examine relationships between prior depression diagnoses and suicidal ideation.
This study was funded by HSR&D (DHI 08-096). Drs. Dobscha and Corson are part of HSR&D's Portland Center for the Study of Chronic, Comorbid Mental and Physical Disorders.
Dobscha S, Corson K, Helmer D, et al. Brief Assessment for Suicidal Ideation in OEF/OIF Veterans with Positive Depression Screens. General Hospital Psychiatry January 23, 2013;e-pub ahead of print.